We have read with great interest the published article by Tapia-Orihuela [1], in which it is stated that hypertension is one of the most frequent comorbidities observed in severe cases of coronavirus disease 2019 (COVID-19) and deaths. In favor of what the author mentioned, COVID-19 has become a pandemic in recent months due to its high transmissibility and mortality. These characteristics cause sanitary systems to collapse, and COVID-19 is not optimally controlled. For this reason, for some months, several investigations have served to understand the behavior of COVID-19 and its risk factors, with hypertension being one of the most studied [2].
Case reports from China describe a higher frequency of COVID-19 cases in patients with hypertension [3–5]. SARS-CoV-2 uses the angiotensin-converting enzyme 2 (ACE2) to bind to the target cell [6]. Based on the increase in the expression of ACE2 in patients treated with ACE inhibitors and AT1 blockers, it is postulated that patients with hypertension and treated with those antihypertensive drugs could be susceptible to an increased susceptibility to SARS-CoV-2 infection and increased risk of severity of the disease [7,8]. However, the association between the presence of hypertension or an increased ACE2 expression and the susceptibility and severity of SARS-CoV-2 infection has not been established in the population affected with COVID-19, including COVID-19 patients in the Americas region. Therefore, we sought to estimate the association between the presence of hypertension and severe COVID-19 disease (defined by the diagnosis of SARS-CoV-2 pneumonia) in the Mexican population.
A cross-sectional study was performed analyzing the data of patients diagnosed with COVID-19 in Mexico. The data were collected by the Secretaría de Salud de México and is available at https://coronavirus.gob.mx. The independent variable was the presence of hypertension. A logistic regression model was performed to assess the association between the presence of hypertension and severe COVID-19 disease, adjusting this association for sex, age, smoking, and comorbidities. The analysis was performed using Stata 14 software (Stata Corp, College Station, Texas, USA).
A total of 4992 SARS-CoV-2 positive cases were included, being 2902 (58.1%) males. The average age was 45.7, and the median was 45 (interquartile range: 34–57). Of the total patients, 1247 (25.0%) had a diagnosis of SARS-CoV-2 pneumonia [434 (34.8%) of these patients had hypertension]. A statistically significant association was found between hypertension and SARS-CoV-2 pneumonia both in the crude model [odds ratio (OR) = 3.27, 95% confidence interval (CI): 2.82–3.79] and in the adjusted model (adjusted OR = 1.50, 95% CI: 1.26–1.79) (Table 1). The study findings suggest that hypertension in Mexican patients would be associated with a greater probability of developing SARS-CoV-2 pneumonia.
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TABLE 1: Unadjusted and adjusted logistic regression analysis of the association between hypertension and pneumonia caused by SARS-CoV-2
Chronic diseases, such as hypertension, affect a significant percentage of the world population vulnerable to COVID-19. In Mexico, 25.5% of the population has hypertension [9]. In a pandemic context, the identification of groups at higher risk to present COVID-19 facilitates the prioritization of resources, especially in countries with health systems with limited capacity to respond to global crises, such as those in the Latin American region. It is necessary to deepen the investigation on the pathophysiological mechanisms that would have a role in the association between hypertension and COVID-19, for the development of recommendations for the management of patients with SARS-CoV-2 and this comorbidity.
ACKNOWLEDGEMENTS
Author contributions: A.H.V. conceived the study. Data were interpreted by A.H.V. All authors drafted the article, and critically reviewed, and approved the final article. All authors assume responsibility for the content of the article.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Tapia-Orihuela RKA. Hypertension and coronavirus disease 2019 mortality.
J Hypertens 2020; 38:1197–1198.
2. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis.
Int J Infect Dis 2020; 9712:30136–30143.
3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Lancet 2020; 395:1054–1062.
4. Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China.
N Engl J Med 2020; 382:1708–1720.
5. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.
JAMA Intern Med 2020; [Epub ahead of print].
6. Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
Cell 2020; 181:271–280.
7. South AM, Tomlinson L, Edmonston D, Hiremath S, Sparks MA. Controversies of renin–angiotensin system inhibition during the COVID-19 pandemic.
Nat Rev Nephrol 2020; [Epub ahead of print].
8. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
Lancet Respir Med 2020; 8:e21.
9. Campos-Nonato I, Hernández-Barrera L, Pedroza-Tobías A, Medina C, Barquera S. Hypertension in Mexican adults: prevalence, diagnosis and type of treatment. Ensanut MC 2016.
Salud Pública Méx 2018; 60:233–243.
